Analysis on treatment status and reasons for failure to receive treatment in newly reported hepatitis C virus infection cases in Tianjin, 2022–2024

Objective To analyze the current status of diagnosis and treatment of hepatitis C and reasons for failure to treatment in newly reported hepatitis C virus (HCV) infection cases in Tianjin, and provide data support for the improvement of local hepatitis C prevention and control strategies and hepatitis C elimination efforts.

Methods A multi-source data integration analysis was conducted. Information about anti-HCV testing was collected from the routine medical institution surveillance system. The data of the basic characteristics and treatment outcomes of newly reported HCV infection cases were obtained from China Information System for Disease Control and Prevention and specific follow-up surveys. Descriptive statistics were used to analyze core indicators such as anti-HCV testing rate and treatment rate. The differences in indicators among populations or institutions with different characteristics were compared with χ² test. Independent factors influencing antiviral treatment were identified by using a binary logistic regression model.

Results From 2022 to 2024, the average annual anti-HCV testing rate was 2.18% in patients in medical institutions in Tianjin, showing an increasing trend (trend χ² =90 084.552, P < 0.05), the average annual anti-HCV positive rate and HCV RNA positive rate showed decreasing trends (trend χ²=472.024, P < 0.05). Significant differences in testing capacity were found among the medical institutions at different levels, with grade III hospitals showing markedly higher anti-HCV and HCV RNA detection rates. Over the three years, a total of 4 434 HCV-infected individuals eligible for antiviral treatment were included in the study, in whom the HCV RNA testing rate was 98.67% (4 375/4 434), and the antiviral treatment rate was 83.81% (3 716/4 434). Binary logistic regression analysis (using treatment initiation as the dependent variable, coded as not treated=0, treated=1) showed that gender, age, occupation, reporting year, location, and level of the reporting hospital were independent factors influencing the treatment outcomes. Women had significantly higher treatment rate compared with men (OR=1.32, 95% CI:1.11～1.57). Those aged ≤45 years (OR=1.68, 95% CI:81.24～2.26) and 46-<70 years (OR=1.51, 95% CI:1.23～1.86) had higher treatment rates compared with those aged ≥70 years . The jobless or unemployed had higher treatment rates compared with farmers (OR=1.35, 95% CI:1.01～1.80). The treatment rates were lower in 2022 (OR=0.18, 95% CI:0.15～0.23) and in 2023 (OR=0.54, 95% CI:0.42～0.70) than in 2024. The treatment rates were significantly higher in grade II hospitals (OR=12.04, 95% CI:2.19～66.24) and grade III hospitals (OR=14.44, 95% CI:2.72～76.74) than in grade I hospitals. Investigation into reasons for failure to receive treatment in 718 HCV infection cases revealed that financial difficulty (24.93%), loss to follow-up (12.67%), and conflict with current disease treatment (11.42%) were the top three reasons.

Conclusion The treatment rate was generally high in the newly reported hepatitis C infection cases in Tianjin. However, economic burden and loss to follow-up remained key obstacles to establish a complete diagnosis and treatment process. Subsequent efforts should be made to further strengthen the implementation of medical insurance policies to alleviate the financial pressure on treatment for vulnerable groups, improve the management mechanism for HCV infected individuals to reduce the loss to follow-up rate, and conduct further research of factors influencing HCV diagnosis and treatment to provide evidence for the development of more precise hepatitis C elimination strategies.